| NPI | 1740387133 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 8625364-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 894) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2016-04-22 |